Physician Alignment
Navigating Behavioral Change to Improve Clinical Outcomes
Health systems and physicians have a unique relationship. Physicians make decisions regarding patient care, which impacts the financial viability of the health system. Physicians look to provide optimal care and often resent hospital-generated guidelines they were not a party to creating which seem to impact care by reducing costs. Thus, a conundrum is created: aligning the goals and aspirations of both the health system and providers to create sustainable programs to enhance patient outcomes while improving financial performance.
Value Based Enterprise
Recruiting top providers is a priority for all healthcare systems today. Accurate provider compensation is essential to attract talent, retain providers, and expand critical services
Co-Management
We have established co-management agreements for key services lines such as general medicine, cardiovascular, oncology, orthopedics and surgical services. Our process begins with setting expectations and developing a shared vision among physicians and hospitals. While there are many details to work through, the overall structure of a co-management arrangement is straightforward.
Dynafios Co-Management Approach
- Program Assessment The initial step in establishing a co-management agreement is to evaluate opportunities for both quality, financial and operational improvements.
- Physician ParticipantsThe next step is to appropriately identify those physicians that are critical to the program and will be key participants in improving performance through the co-management process.
- Management Duties Determining the scope of the management duties is critical to the process of identifying the FMV compensation for payment to the physicians.
- Valuation Letters Important to any physician compensation for services is establishing the FMV for the level of work and the scope of the management duties. Critical to the process is to ensure the KPI’s or indicators are commercially reasonable.
- Physician Education Dynafios utilizes an initial kickoff meeting to not only educate key stakeholders on co-management, but to also initiate the process of designing the contract and indicators critical to the success of the agreement.
- Negotiation of Terms From the initial meeting to the kickoff, this is the time the Dynafios team works with local counsel and each of the physician managers to appropriately negotiate the terms of the agreement.
- Indicator Definition A proposed list of indicators spanning 3 years is presented to the physicians and hospital executives. The indicator specifics include population criteria, numerator and denominator definitions, baselines, anticipated goals and any exclusionary criteria that might apply. Finally, there is a measurement period established that reveals the timing of “on the clock” for results to achieve the bonus compensation.
- Finalize Contract & Kick Off Dynafios works with all parties to successfully finalize the terms to execute an agreement. Just 90 days from start to kick-off.
Physician Contract Compliance Including FMV Opinion Letters
Ensuring all of your bases are covered…Mitigating risk with physician agreements.
With healthcare business arrangements growing increasingly complex and financial reporting of healthcare organizations under heightened scrutiny, fair market valuations (FMV), auditing and contract adjudications are more important than ever before.
Our team of senior appraisers utilize both national and proprietary databases for FMV opinion letters in a variety of business, contractual and asset valuation work. From FMV opinion letters to contract adjudications, we have an experienced team that can provide the third-party review for all your compliance needs.
In addition to our compliance services, Dynafios also offers software products that help reduce compliance risk with physician agreements. The DYNAFIOS APP is an easy to use physician timekeeping and contract compliance app that helps ensure all contractual relationships are compliant and within FMV.
Value Based Enterprise – Limited Risk
With recent changes to the Stark and AKS statutes created by the Regulatory Sprint to Coordinated Care, providers have a significantly increased ability to move towards higher quality, value-based care arrangements. With the simple requirements of a Value Based Purpose, Value Based Enterprise, Value Based Arrangement and Value Based Activities, organizations can now manage target patient populations in tighter care coordinated protocols.
Who can be a Value Based Enterprise (VBE)?
A VBE can be considered a network of providers engaged in value-based activities. Any type of organization can be a Value Based Enterprise, including CIN, ACO or other contractual professional services agreement. VBE’s must have an accountable body or person who is responsible for the financial and oversight of the VBE and a governing document that describes the VBE, the purpose and participant’s intent to achieve the value-based outcomes. VBE must have a target patient population selected using legitimate and verified criteria defining the need for improvement.
What is a Value Based Purpose?
The Value Based Purpose must include one of four (4) purposes:
- Care coordination
- Quality of care improvement
- Reduction of cost without reducing quality
- Transition in payments from volume to value for care delivery
What is a Value Based Arrangement?
Written agreement specifying the target patient population and value-based activities to achieve the VBE purpose. It must include the target population, description of the remuneration, and term of the agreement.
What is the Benefit of a Value Based Enterprise?
Structuring relationships with providers through a VBE provides new opportunities to target activities related to care coordination, directed referrals, and cost standardization given the new AKS and Stark safe harbors and exceptions. Partnering with post-acute providers can now include in-kind remuneration such as cost sharing for Care Coordinators. Direct referrals to specific providers or suppliers are allowed for the target patient population.
Why Dynafios? OR How Do I Get Started?
Dynafios has decades of experience in bringing together providers and organizations to create higher quality care and cost predictability across a variety of settings and patient populations. Our clinical consulting team brings the latest evidence-based practices and works with providers and other clinical staff to implement and track improved outcomes.
Results Driven
Founded in 2004 Dynafios continues to grow and expand throughout the healthcare industry assisting clients in the areas of physician alignment, analytics and compliance services. With a seasoned team of analysts and consultants, Dynafios closely works with each client to improve the clinical process of care, patient experience, operational efficiencies and outcomes…all critical in a value-based purchasing environment! Our innovative products 4CAST and The DYNAFIOS APP provide clients the ability to understand clinical variation, provider performance and help organizations efficiently manage time activities that require payment for services.
Cassandra Couey, MSN, RN
With deep experience in the healthcare industry, Cassy Couey brings a diverse clinical background spanning critical care, emergency medicine, surgical services, cardiovascular care, leadership, and quality improvement. Her ability to bridge frontline clinical expertise with strategic oversight makes her a vital force in driving healthcare program success.
Cassy holds a Bachelor of Science in Nursing from the University of Texas at Arlington and a Master of Science in Nursing with a specialization in Health Informatics from Grand Canyon University. Her academic and professional journey reflects a strong commitment to leveraging technology and data to enhance patient outcomes, streamline operations, and support evidence-based decision-making.
Kelly Witter, MSN, RN
Kelly Witter has over 25 years of healthcare experience, including two decades in senior leadership roles. Renowned for her strategic vision and operational acumen, Kelly has successfully led initiatives to standardize clinical operations, evaluate provider compensation models, streamline onboarding processes, and build high-performing physician teams. In past roles, her leadership was instrumental in establishing a formal Physician Leadership Council, advancing organizational alignment and physician engagement across networks.
Recognized as a subject matter expert in oncology, palliative care, hospice, women’s health, pediatrics, hospital medicine, and provider network development, Kelly brings this expertise to engagements. In addition to her consulting work, she serves as a university faculty member, teaching nursing and health science programs and mentoring the next generation of healthcare professionals.
Heather Domit, MSN, RN
Heather Domit brings over a decade of impactful experience in the healthcare industry. Recognized for her ability to balance clinical excellence with financial stewardship, Heather has a proven track record of driving operational efficiency and enhancing care delivery across complex healthcare environments.
Her expertise spans a wide range of acute care specialties, including cardiovascular services, orthopedics, neurology, neurosurgery, intensive care, and procedural areas. Heather is highly regarded for her ability to lead process improvement initiatives that optimize performance, elevate patient outcomes, and support sustainable growth within health systems.